International Journal of

Environmental Research

and Public Health

Case Report

Lessons Learned from Battling COVID-19:The Korean Experience

Sang M. Lee 1 and DonHee Lee 2,*1 College of Business Administration, University of Nebraska-Lincoln, Lincoln, NE 68588, USA; slee1@unl.edu2 College of Business Administration, Inha University, Incheon 22212, Korea* Correspondence: dhlee04@inha.ac.kr; Tel.: +82-32-860-7737

Received: 26 September 2020; Accepted: 15 October 2020; Published: 16 October 2020�����������������

Abstract: Background: The COVID-19 pandemic has swept the world like a gigantic tsunami, turningsocial and economic activities upside down. Methods: This paper presents some of the innovativeresponse strategies implemented by the public health system, healthcare facilities, and government inSouth Korea, which has been hailed as the model country for its success in containing COVID-19.Korea reinvented its public health infrastructure with a sense of urgency. Results: Korea’s successrests on its readiness, with the capacity for massive testing and obtaining prompt test results, effectivecontact tracing based on its world-leading mobile technologies, timely provision of personal protectiveequipment (PPE) to first responders, effective treatment of infected patients, and invoking citizens’community and civic conscience for the shared goal of defeating the pandemic. The lessons learnedfrom Korea’s response in countering the onslaught of COVID-19 provide unique implications forpublic healthcare administrators and operations management practitioners. Conclusion: Since manyepidemic experts warn of a second wave of COVID-19, the lessons learned from the first wave will bea valuable resource for responding to the resurgence of the virus.

Keywords: COVID-19 pandemic; Korean response strategies; lessons learned; public healthsystems; equity

1. Introduction

The recent spread of the coronavirus (COVID-19) has thrown the world into total chaos. COVID-19has caused not only a health and social crisis of immense proportions forcing people to deal with thefear of infection and the physical, emotional, and financial damage from government recommendedphysical distancing, but it has also caused a global economic turmoil [1,2]. The virus started spreadingin Wuhan, China in late December 2019, and became a shocking pandemic by mid-March 2020; by thistime, it had already caused several hundred deaths, disrupted the global economy, and forced countriesto close their doors to visitors [3–5]. The World Health Organization (WHO) defined COVID-19as “an infectious disease caused by a newly discovered coronavirus” [6]. WHO declared the novelcoronavirus outbreak a global pandemic, the highest category for infectious diseases, on 11 March2020, officially notifying the global community that a health crisis is upon us [3,7].

Major infectious diseases that have occurred during the past 20 years include Severe AcuteRespiratory Syndrome (SARS: 2003), novel influenza virus (H1N1: 2009), Middle Eastern RespiratorySyndrome (MERS: 2012), avian influenza (2014 and 2017), and COVID-19 (2019), most of whichwere originally reported in China. Particularly, COVID-19 has potent infectivity, implying that itspreads quicker and its mutations are more complex than other infectious diseases. As the numbers ofconfirmed cases and deaths began to rise exponentially, halting the coronavirus became a global issue.In addition to the immediate health concerns, the COVID-19 pandemic disrupts and destroys globalsupply chains along the associated systems of purchasing, manufacturing, logistics, and sales [8].

Int. J. Environ. Res. Public Health 2020, 17, 7548; doi:10.3390/ijerph17207548 www.mdpi.com/journal/ijerph

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The Global Risks Report 2020, released recently at the World Economic Forum (WEF) in Davos,Switzerland, emphasizes that an infectious pandemic is one of the top 10 risks that could cause a globaleconomic crisis (WEF, 2020a). The report described infectious diseases as “low likelihood, high impact”events, so that when an outbreak occurs it will have a major detrimental impact on the global economyand society. The Global Risks Report further stated that, although many countries have establishedcertain epidemic prevention systems since the Ebola epidemic (which occurred in West Africa in2014), healthcare systems that need to respond to novel infectious diseases (e.g., SARS, Zika virus,and MERS) are still outdated [9]. No country is perfectly prepared to control an infectious disease,thus collective vulnerability in dealing with the social and economic effects of a pandemic is a globalissue. Especially, governments must establish appropriate infrastructures for epidemic emergencymanagement, transparent media for information disclosure regarding the emergency, and call on thecollective wisdom of citizens to fight the disease [10–12].

In Korea, the information pertinent to COVID-19 has been promptly and transparently disclosedthrough the Korea Center for Disease Control and Prevention (KCDC), local government websites,and automated text message systems, which communicate in real-time the recent locations wherenewly diagnosed patients have traversed, thereby encouraging the voluntary civic engagement ofcitizens (e.g., handwashing, wearing masks, and social distancing). One of the biggest differencesbetween the current pandemic and past similar infectious disease cases is that COVID-19 eruptedwhen digital transformation was in full operation, especially in Korea [13]. Owing to the bestinformation and communications technology (ICT) infrastructure and cloud-based mobile environmentin the world, Korea took full advantage of its technological capabilities for managing the spread ofCOVID-19. For example, Korea introduced an innovative drive-through testing system for massivedaily tests, almost instantaneous analysis of tests (within five minutes for the results), mobile technologybased geotagging for contact tracing, and the use of online-based remote work activities (e.g., videoconferencing, tele-medicine, working from home, and online classes) [14]. Such an advanced digitalenvironment positively contributes to preventing a wide spread of the pandemic in Korea [1,8,15].

The new normal in the pandemic period is truly painful to all people, especially for those who havebeen engaged in air travel, tourism and hospitality, sports, entertainment, education, and large operatingsystems. In this new environment, people are advised to avoid direct human-to-human contacts.Thus, the digital infrastructure and operational innovations play renewed significant roles [8,16].For example, online-ordered deliveries, curbside pickups, and “untact” (no human contact) servicesare flourishing [17]. With the increased demand for remote and untact services, many innovative appsare also being developed (e.g., apps to locate the nearest place to purchase masks, to have a rental cardelivered to the house, to have desired meals delivered in the shortest time, etc.) Specifically, the needfor telemedicine has been highlighted as patients with pre-existing conditions or chronic diseases areadvised to refrain from visiting their regular healthcare providers due to hospitals over-crowded withcoronavirus patients [1].

Currently, COVID-19 has spread across the globe, without showing any sign of abatement as noeffective general cure or vaccine for the pandemic is available. The onslaught of virus-infected patientshas pushed the healthcare systems of many countries to the brink of collapse [7,18]. In those nationswhere health systems are still holding on, the prevailing social anxiety pertaining to the stretchedcapability of medical staff and facilities is extremely high [7,18]. The collapse of a healthcare systemrefers to the downfall of the first line of defense (e.g., treating a patient effectively until the next patientrequires help) in the face of communicable and infectious diseases. Such a situation can paralyzemany people with anxiety and fear that their health support system may collapse and not be ableto protect them from the pandemic. The current pandemic clearly indicates the need for the publichealthcare system to be agile, flexible, and resilient to encounter this emergency health crisis [5,19].This is precisely the reason that innovative measures must be developed based on the lessons learnedfrom the current and past pandemic crises.

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This study attempts to present directions for potential changes in the crisis response systems ofpublic healthcare worldwide, by analyzing COVID-19 pandemic response cases, both successes andfailures, in Korea. More specifically, this study has the following objectives: (1) To analyze Koreanexperiences with cases where healthcare facilities failed to prevent previous infectious diseases fromspreading, and how these failures served the government in devising effective approaches to encounterthe COVID-19 pandemic, (2) To dissect cases that showed innovative and successful response measuresto deal with the COVID-19 pandemic, and (3) To elaborate on suggestions for crisis management basedon the lessons learned from these COVID-19 response cases in Korea.

The rest of this paper is structured as follows. In Section 2, we present a review of relevant literatureon global infectious diseases and COVID-19 as well as several real cases of Korean healthcare providersin managing the COVID-19 pandemic. Section 3 presents the innovative response strategies deployedin Korea (K-response model) to fight the pandemic. In Section 4, we summarize the important lessonslearned from the Korean experience. We conclude the study in Section 5 by discussing implications ofthe study results, limitations of the study, and future research needs.

2. Relevant Literature

2.1. Global Infectious Diseases and COVID-19

Infectious diseases refer to those “caused by pathogenic microorganisms, such as bacteria, viruses,parasites, or fungi; the diseases can spread, directly or indirectly, from one person to another” [20].These diseases can infect people by contact with other humans, animals, or other reservoirs infectedby a pathogen or toxic substance. Additionally, communicable diseases refer to those that directlyor indirectly spread between humans or between humans and animals. Thus, an infectious diseasepandemic is an epidemic that has the potential to be easily transmitted and to affect the globalpopulation due to its highly infectious nature [21].

Since the Second World War, the world has seen many innovative developments in vaccines andantibiotics; such advances have ensured that communicable and infectious diseases are reasonablycontrolled [11]. An important study by the Institute of Medicine, “Emerging Infections: MicrobialThreats to Health in the United States,” shed some light on the issues involved with novel infectiousdiseases [22]. Soon thereafter, the WHO passed the resolution “Global Health Security: Epidemic Alertand Response” in 2001 [23], which enabled the collection of information and enforcement of actionsthrough cooperative work by inter-governmental agencies, non-governmental institutions, privateorganizations, and governments around the world.

In 2003, the SARS outbreak in China quickly spread fear of a pandemic that could cross bordersand affect countries worldwide. Particularly, China failed to promptly and transparently discloseepidemic information. The Chinese government reported the outbreak to the WHO several monthsafter the first confirmed case of SARS, thus delaying effective response measures by world organizations.Immediately, the WHO raised the alert that the SARS outbreak was of high risk, subsequently issuinga travel advisory notice (e.g., advising a travel ban to places where the epidemic had occurred) aimedat suppressing the spread of the disease. As a result of this experience with SARS, many countriesworldwide recognized the importance of a global infectious disease governance system, which shouldstretch beyond the governance of each country [24]. In 2005, the International Health Regulationswere revised and expanded to include not only communicable diseases but also other possible threats(i.e., biological terrorism and events that induce international public health crises). Nevertheless,other highly contagious diseases have continued to emerge throughout the last two decades.

In the presence of healthcare emergencies, such as the infectious and coronavirus outbreaksdiscussed above, public healthcare should be available throughout the country not only with rapidresponse but also based on an equitable basis [5,19,25]. The sense of equity involves a person’sperception of the input and output relationship which should not create tension or displeasure as aresult of cognitive dissonance [26]. Rousseau [27] defined equity as a function of customer’s perception

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in a service encounter experience. Equity is realized when a person believes his/her outcome concerningresources invested is in harmony with that of others [28]. Equity theory has become the theoreticalfoundation for service recovery as it helps create possible recovery approaches for service failuresthrough recognition, procedures, and mutual interaction involving customer complaints [29,30]. It isimportant that people perceive that a service is being provided equitably. Especially in a crisis such asthe COVID-19 pandemic, it is imperative for people to perceive that urgent public healthcare is beingprovided equitably [5]. Such perceived equity inspires people to be transparent about their activities(e.g., infection status, contacts, self-quarantine, etc.) that are the first line defense against the disease.This study examines the successes and failures of the Korean healthcare organizations in their efforts tocontain COVID-19, from an equity perspective relating to healthcare services.

2.2. Cases of COVID-19 among Healthcare Facilities in Korea

Korea has a history of responding poorly to infectious diseases (e.g., SARS, H1N1, and MERS).In 2012, Saudi Arabia was the first country to experience the MERS outbreak. Korea was the mostdetrimentally affected country by the virus as many Korean global firms have operations in SaudiArabia. In Korea, the first MERS case was confirmed in 2015 and its rapid spread resulted in a significantnumber of casualties which heightened anxiety that swept throughout the country. Furthermore,the serious blow caused to the national economy clearly revealed the weakness of Korea’s infectioncrisis management system [10,31]. The Korean government’s limited response capacity regardingMERS and its poor communication to its citizens weakened people’s trust in the government’s infectioncrisis management policies to the point where many started believing that the national epidemicprevention system could easily collapse [31]. There were 185 confirmed cases of MERS among thosewho traveled to the Middle East, 38 of whom died in 2015. The causes of the high mortality rate couldbe attributed to the limited capacity of the healthcare delivery system for handling the new virus,shortage of epidemic prevention equipment for medical first responders, and the moral hazard amongpatients [10,31].

After painful experiences in dealing with past diseases, the Korean government was determined toestablish an effective infrastructure to deal with future epidemic emergencies, with KCDC as the controltower. The new infrastructure includes an increased number of negative-pressure isolation wards,real-time systems for data and transparent information collection and analysis, and modernization of thehealthcare system. Since the MERS crisis, the Korean government has reinvented a national healthcaredelivery system equipped with advanced digital technologies and expanded the facilities specificallydesigned to deal with infectious diseases (e.g., the creation of negative pressure wards) [10,31].

Thus, KCDC was well prepared to respond effectively to epidemic emergencies when the COVID-19crisis occurred. When COVID-19 began to spread, the Korean government raised the response level toserious (the highest) on 23 February 2020 and promptly established the Central Disaster and SafetyCountermeasure Headquarters, headed by the Prime Minister to bolster government-wide responsesto the virus with KCDC as the command center [32].

According to the Korea Economic Daily [33], the rapid spread of COVID-19 around the world,especially in China, Italy, and in the United States, and the subsequent spike in the number of deaths,has brought global attention to the prevention model and early response operational strategy implementedby Daegu city, the epicenter in Korea. Daegu took aggressive actions with speed to prevent the collapseof its healthcare system without placing the city in a lockdown [34]. The city government performedaggressive screening, testing, and quarantining of patients in the communities that were confirmed tohave, or suspected of having, infected citizens.

According to KCDC [32], Daegu city did not implement this approach at the onset of the COVID-19outbreak in Korea (18 February 2020). Daegu and the North Gyeongsang province (where Daegu islocated) were heavily criticized for the exponential growth rate of infected patients as ground zero.This region accounted for 70% of the confirmed cases in Korea, caused primarily by the ShincheonjiChurch gatherings (worship services where people sat on the floor shoulder-to-shoulder) and the

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mass infections that occurred among the first medical responders while providing care services.The city government performed screening tests of the entire congregation of the Shincheonji Church,isolated severely ill patients, and secured enough quarantine beds for those in need of treatment andisolation. To achieve this, Daegu operated a public-private partnership (PPP) network (composed ofthe Emergency Response Advisory Group, the Daegu Medical Association, and three infectious diseasemanagement support groups), which served as the control team for the COVID-19 epidemic [35].

The PPP collaboration network deployed several response strategies against COVID-19. First,private hospitals were converted into isolation hospitals. A group chatroom for the control team wascreated, through which experts held discussions about the situation throughout the night. Throughthese discussions, the Daegu Dongsan Hospital and the Ministry of Defense were contacted and askedto secure as many beds as possible at the Daegu Armed Forces Hospital and Daejeon Hospital. At thattime (18–25 February), there were only about 30 available negative pressure wards in Daegu, and someconfirmed patients died while waiting to be admitted into a hospital.

Second, the entire congregation of the Shincheonji Church was tested, and those who hadsymptoms were identified. On the night of 18 February 2020, 70% of confirmed cases of COVID-19were members of the Shincheonji Church. The Daegu secured information on the 3000 members of theChurch, identified them, and ordered 544 symptomatic patients to remain in self-quarantine for twoweeks. A leading physician at the Kyungbook National University stated that “the rate of confirmedcases reached 80% among patients who showed symptoms; so, if we had not prompted early isolationof those Shincheonji Church members who showed symptoms, Daegu might have been in the samesituation as Europe or the United States” [33].

Third, members of the Daegu Medical Association provided care to those patients in self-quarantinevia video calls using 100 outgoing-call-only smartphones provided by Daegu city, hence eliminatingthe previously existing void in the response system. These response activities represent innovativestrategies implemented in the initial stage of the Covid-19 invasion (e.g., aggressive testing, almostimmediate test results, contact tracing of infected persons, and prompt treatment of severely ill patients).The mortality rates in New York, USA (6.44%) and in Madrid, Spain (12.62%) are much higher thanthat in Daegu, Korea (2.76%) as of 1 June 2020 (see Table 1). These high mortality rates indicate thattheir patient monitoring and healthcare facilities operations were not systematic. It is evident that “themost potent operational strategy amid the lack of a cure is not search and destroy, but identificationand isolation of symptomatic citizens” [33].

Fourth, drive-through screening centers were developed for the first time in the world, supportedby a world-leading ICT infrastructure [36]. The Yeungnam University Medical Center, in the vicinityof Daegu, had admitted a COVID-19 patient on 19 February 2020, which resulted in the closing ofthe emergency room (ER) and prompted self-isolation of its medical staff. Based on this experience,the Medical Center decided to establish a drive-through screening center, which eliminated the risk ofshutting down ER and self-quarantining first responder medical staff. Moreover, the existing screeningcenter was inefficient in handling the large crowd of people needing testing in a small space. Thus,this was another innovation in need that led to the strategy of developing drive-through testing centers.Laura Bicker, a BBC correspondent in Seoul, referred to the drive-through testing centers as “such aclever idea and so quickly set up”. Sam Kim, an economics reporter at Bloomberg, mentioned thatKorea “once again proved to be among the world’s innovative nations,” and Ian Bremmer, president ofthe Eurasia Group, a think tank in the US, stated that “innovation drives resilience” [37]. Innovativeoperation strategies are critical in fighting such a formidable global pandemic as COVID-19.

Finally, creative applications of the national ICT infrastructure and rapid development of mobileapps by young entrepreneurs have helped analyze the details about confirmed patients and theircontacts (e.g., locations, people contacted, and travel patterns before their infection confirmation).KCDC [32] collected and released relevant information (e.g., regions, pockets of high infection density,and places visited) on COVID-19 patients in real-time. Such transparency regarding the handling ofCOVID-19 patients encouraged citizens to voluntarily participate in physical distancing and personal

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hygiene. This is another strategy that has helped Korea effectively manage the crisis when comparedto other nations such as Italy and the US. In Korea, after KCDC disclosed the movements of the firstCOVID-19 patient in Daegu on 18 February, all the places the patient had visited were immediatelyshut down and disinfected; moreover, the government analyzed security footage (e.g., CCTV fromthe entrance of the church) to help identify and isolate anyone who might have come into contactwith the patient. Local governments sent out emergency alert text messages to provide real-timeupdated information so that the population of other provinces and cities could be advised not to visitthe infected locations.

Table 1. Cities most affected by COVID-19 and Daegu’s strategies to combat the pandemic.

Major City(Country)

Number ofConfirmed Cases

Number ofDeaths

MortalityRate

Response Strategies Implemented byDaegu to Deal with the Pandemic

Worldwide 6,263,632 375,542 6.00% • Converted private hospitals intoisolation hospitals

• Identified members of Shincheonjichurch who had symptoms via phonesurveys and screening tests

• Provided 100 smartphones to civilianphysicians to assist them indiagnosing, via video calls, patientsthat needed to be self-quarantined

• The first city to implementdrive-through screening centers(Chilgok Kyungbook NationalUniversity Hospital, YeungnamUniversity Medical Center)

• The first city to implement mobilescreening centers (management ofhigh-risk groups such as Shincheonjicluster/nursing home residents)

• Ran 15 residential treatment centers incollaboration with the government

New York (US):From 20 Jan. 2020

373,040(1,811,360)

24,023(105,165)

6.44%(5.81%)

Madrid (Spain):From 31 Jan. 2020

68,852(239,638)

8691(27,127)

12.62%(11.32%)

Lombardy (Italy):From 31 Jan. 2020

89,205(233,197)

16,143(33,475)

18.10%(14.35%)

Hubei (China):From 31 Dec. 2019 68,135 (84,154) 4512

(4638)6.62%

(5.51%)

Daegu (Korea):From 20 Jan. 2020

6885(11,541)

188(272)

2.76%(2.36%)

As of 1 June 2020 (unit: person), Sources [38–43].

Table 1 summarizes the current (as of 1 June 2020) state of the cities with the greatest number ofconfirmed cases among countries most affected by COVID-19, and the innovative operational strategiesimplemented by Daegu to respond to the COVID-19 pandemic. Daegu, the epicenter of COVID-19cases, is currently in the process of being transformed into a smart city. It is noteworthy that thecity/area where an explosive outbreak of COVID-19 cases occurred had higher mortality rates thanthat of the country as a whole.

Table 2 summarizes statistics of the number of confirmed COVID-19 infection cases, deaths,and mortality rates among the top 10% of 169 countries, including Italy, China, and South Korea, as of7 September 2020. The table also indicates average statistics for the entire 169 countries.

Figure 1 shows the mortality rates of the top 10 countries for COVID-19 infection, including SouthKorea, as of 7 September 2020 (including the average for the entire 169 countries as a group). The barsin the figure show the number of deaths per 100,000 population. In the early phase of the coronavirusspread, South Korea recorded the second highest number of infected persons after China. However,as shown in Tables 1 and 2 and Figure 1, Korea initiated aggressive strategies for testing and contacttracing based on its well-established public health infrastructure. Thus, the country has been able toflatten the curve of infected cases which resulted in relatively low rates of deaths/infected cases andmortality (deaths/100,000 population) [44].

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Table 2. A summary of COVID-19 statistics for selected countries (7 September 2020).

Ranking Based on Confirmed Cases Country Confirmed

Case Deaths Death/Case Mortality:

Deaths/100k Population

1 United States

6,276,365 188,941 3.00% 57.75

2 India 4,204,613 71,642 1.70% 5.30 3 Brazil 4,137,521 126,650 3.10% 60.46 4 Russia 1,022,228 17,768 1.70% 12.30 5 Peru 683,702 29,687 4.30% 92.80 6 Colombia 666,521 21,412 3.20% 43.13

7 South Africa

638,517 14,889 2.30% 25.77

8 Mexico 634,023 67,558 10.70% 53.54 9 Spain 498,989 29,418 5.90% 62.96 10 Argentina 478,792 9859 2.10% 22.16 11 Chile 422,510 11,592 2.70% 61.89 12 Iran 386,658 22,293 5.80% 27.25

13 United

Kingdom 349,500 41,640 11.90% 62.63

14 France 347,268 30,730 8.80% 45.87 15 Bangladesh 325,157 4479 1.40% 2.78

16 Saudi Arabia

320,688 4081 1.30% 12.11

17 Pakistan 298,903 6345 2.10% 2.99 19 Italy 277,634 35,541 12.80% 58.81 35 China 90,058 4730 5.30% 0.34

75 South Korea

21,296 336 1.60% 0.65

Average of 169 countries 160,365 5227 2.91% 11.99 Source [45].

Figure 1. Mortality rates in the most affected countries. Source [45].

The crisis caused by a pandemic can lead to issues of equity in the public healthcare service [46]. Particularly, failures in providing equitable public healthcare and in community participation in the decision making process should not be repeated. Thus, it is necessary to analyze the successes and failures experienced in the current situation (i.e., the first wave) as a preparation for the possible

Mortality: Deaths/100K population (7 September 2020)

Figure 1. Mortality rates in the most affected countries. Source [45].

Table 2. A summary of COVID-19 statistics for selected countries (7 September 2020).

Ranking Based onConfirmed Cases Country Confirmed

Case Deaths Death/CaseMortality:

Deaths/100kPopulation

1 United States 6,276,365 188,941 3.00% 57.752 India 4,204,613 71,642 1.70% 5.303 Brazil 4,137,521 126,650 3.10% 60.464 Russia 1,022,228 17,768 1.70% 12.305 Peru 683,702 29,687 4.30% 92.806 Colombia 666,521 21,412 3.20% 43.137 South Africa 638,517 14,889 2.30% 25.778 Mexico 634,023 67,558 10.70% 53.549 Spain 498,989 29,418 5.90% 62.9610 Argentina 478,792 9859 2.10% 22.1611 Chile 422,510 11,592 2.70% 61.8912 Iran 386,658 22,293 5.80% 27.2513 United Kingdom 349,500 41,640 11.90% 62.6314 France 347,268 30,730 8.80% 45.8715 Bangladesh 325,157 4479 1.40% 2.7816 Saudi Arabia 320,688 4081 1.30% 12.1117 Pakistan 298,903 6345 2.10% 2.9919 Italy 277,634 35,541 12.80% 58.8135 China 90,058 4730 5.30% 0.3475 South Korea 21,296 336 1.60% 0.65

Average of 169 countries 160,365 5227 2.91% 11.99

Source [45].

The crisis caused by a pandemic can lead to issues of equity in the public healthcare service [46].Particularly, failures in providing equitable public healthcare and in community participation in thedecision making process should not be repeated. Thus, it is necessary to analyze the successes and failuresexperienced in the current situation (i.e., the first wave) as a preparation for the possible onslaught of thesecond wave of the pandemic. To conduct an in-depth analysis of the causes and consequences of theCOVID-19 virus spread in Korea, we examine the operational procedures and strategies implementedby several healthcare facilities. Many seriously ill patients with the virus were diagnosed or infectedin ER. Even in a normal day, ER operates at the disaster level [47]. The COVID-19 pandemic severely

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tested the agility, flexibility, and resilience of ER operations at every hospital. The following five casesare investigated based on the information released by KCDC [32].

2.2.1. Hospital A

Hospital A is an 808-bed tertiary general hospital located in Seoul with 2000 employees. The hospitalprovides care to an average of 600 inpatients and 2000 outpatients daily. The first COVID-19 case inthis hospital was confirmed on 21 February 2020, and was consequently quarantined for two weeksuntil 5 March. A careful contact tracing of the patient resulted in 14 additional confirmed cases withinthe hospital. The first confirmed case in the hospital was a patient aide who helped patients movefrom the ward to the lab. Prior to the diagnosis, it was found that this aide had helped 207 patients.After the diagnosis of the first confirmed case, the hospital’s ER and outpatient clinics were closedand quarantined.

2.2.2. Hospital B

Hospital B is a 251-bed general hospital with 644 employees located in Seoul. It was closed fortwo weeks, from 8 to 22 March, due to a patient’s dishonesty. The patient was a resident of Daegu Citybut falsified his home address when hospitalized. After being diagnosed with COVID-19, the patientwas isolated. The hospital shut down its outpatient center, some wards, and ER. The particular concernwhich this patient caused was the fact that the person had visited the artificial kidney unit, contactingmany high-risk patients. Although there was no additional positive case found, the hospital wasquarantined for two weeks.

2.2.3. Hospital C

Hospital C is a psychiatric hospital (housed on floors 8–11 in a high-rise building) in Daegu with286 inpatients and 72 employees. The first positive diagnosis of COVID-19 was made on 26 March,after which the number of confirmed cases increased at an alarming rate. This case happened because thefirst patient was originally at a convalescent hospital (located on floors 3–7 in the same building) wherethe first positive case was tested on 20 March and spread quickly to133 patients. When the first casewas confirmed at the convalescent hospital, the building management firm failed to disinfect the entirebuilding and consequently the virus spread to Hospital C. Hospital C conducted virus tests on its ownemployees but did not screen all patients because all the employees were tested negative. There were 196infected patients as of 20 April and the hospital was closed. KCDC conducted a thorough investigationof Hospital C and found that the mass infection occurred because of the failure to screen all patients [32].Further, due to the nature of the psychiatric hospital (i.e., closed wards in confined spaces), the infectionspread rapidly, and subsequently the number of infected cases increased at an accelerated rate.

2.2.4. Hospital D

Hospital D is a 700-bed general hospital located in Seongnam City, in the vicinity of Seoul,with 1400 employees, including 140 specialists in 26 specialty areas. The hospital serves an averageof 5000 patients daily. One patient was discharged after treatment in the hospital and returned toreceive outpatient care. The same patient became very ill and was brought to ER and diagnosedwith COVID-19 infection on 5 March. Consequently, a mass infection of the virus occurred amonghealthcare providers within the hospital (43 confirmed cases). Hence, the hospital was closed from6 March to 12 April (38 days). Hospital D provided incomplete information to KCDC, as a person inneed of isolation was omitted from the list [32].

2.2.5. Hospital E

Hospital E implemented proactive measures to suppress the spread of COVID-19. All patientsand their respective caregivers were required to fill out a paper-based health questionnaire upon

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admission. However, there were concerns about having the patients complete the questionnaire, whichmight take too much time while they were crowded in a limited space. In order to reduce crowdingand minimize hospital-acquired virus infections, a mobile health questionnaire was delivered by thehospital. The questionnaire asked patients to precisely list all travel to foreign countries, visits toregions or facilities with confirmed cases, and any symptoms of fever or respiratory difficulties.

Hospital E reported that (https://www.yuhs.or.kr/en/), between 12 and 19 March, an average of6136 people submitted the mobile health questionnaire each day. On average, the questionnaire took1 min 29 s to complete (8.9 s for each of 10 items). Further, Hospital E sent the mobile health questionnaireto visitors scheduled for outpatient services or testing at 6 AM on the day of the appointment viaKakaoTalk (Korean SNS) or text message. Once the patient had completed the questionnaire, a quickresponse (QR) code was generated. If the patient had self-reported COVID-19-related flagging, a redQR code was assigned, and no flagging was noted with a black QR code. Only visitors who had thered QR code were issued with proper stickers and allowed to enter the hospital.

The patients with the red QR code were required to undergo an additional evaluation at thehospital entrance. Based on this evaluation, they were either directed to a designated safe care facilityor were not allowed to enter the hospital for treatment. Moreover, visitors who were not able to usea mobile questionnaire or were not aware of this requirement were provided with the paper-basedquestionnaire at the entrance. The implementation of this mobile questionnaire was an effectivemeasure to reduce hospital-acquired infections, among the patients and between employees andpatients (hospital press release; https://www.yuhs.or.kr/en/).

Table 3 presents a summary of problem causes and response strategies employed by thesample hospitals.

Table 3. Example hospitals with confirmed COVID-19 cases.

Case Cause Response Lesson

Hospital A Noncompliance withregulation by a patient aid

• Emergency room andoutpatient center closure

• Quarantined for two weeks• Testing of inpatients

and employees• Employees were allowed to

use only personal vehiclesto commute

• Staff must comply withregulations (mandatorymask use)

Hospital B False statement by a patient• Hospital closure• Testing of all who came into

contact with the patient

• The need to takeresponsibility if a publicproblem occurs (owing to thepatient’s false statements)and to have maturecivic consciousness

Hospital C Blithe response• Hospital closure• Testing of all patients

and employees

• The need to test the wholearea that was potentiallyinfected (in this case, theentire building)

Hospital DSecondary mass infectionfollowing initial patient

infection

• Hospital closure• Testing of all who came into

contact with the patient• Staff self-quarantine

• The need to ensure data andinformation transparency

• The need for full cooperationwith the Korea Center forDisease Control andPrevention (KCDC)

Hospital E Implemented proactivemeasures

• Required a paper-basedhealth questionnaire

• Sent KakaoTalk or textmessage with thehealth questionnaire

• To reduce crowding andminimize hospital-acquiredvirus infections, variousmeasurement methods wereused by the hospital

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3. Korean’s Innovative Response Strategies to the COVID-19 Pandemic

During a pandemic crisis, the government should encourage people to take preventive measures fortheir own safety, and share information transparently, including that on the risk involved. After failingto effectively manage the MERS outbreak in the past, Korea improved its public health infrastructureand expanded its relevant medical facilities. This experience enabled the Korean government andhealthcare providers to develop innovative response strategies to COVID-19.

3.1. Innovative Testing System

Drive-through and walk-through testing centers were implemented for the first time in the world.These systems have been heralded as a creative response model to the pandemic, and they have beenbenchmarked and copied by countries worldwide [14,36,48]. The compelling motivation for thesesystems was rooted in the challenging problems experienced by some screening centers. These centerswere overwhelmed by an onslaught of patients with suspected COVID-19 symptoms. The averagewaiting time for a screening was as high as six hours or even longer in some cases, consequently raisingserious cross-infection concerns [32].

A drive-through screening center can process suspected patients through several steps (e.g.,completion of the patient questionnaire, physician’s examination, sample collection, and education)without them getting out of their automobiles, hence shortening the testing duration to less than10 min per patient [32]. These testing systems lower the risk of infection, minimize contact betweentest recipients and healthcare providers, and save time.

In a regular screening center, the room must be disinfected and ventilated after treating eachpatient. Drive-through centers, on the other hand, do not require such procedures, thus not onlydiminishing the risk of contamination but also greatly increasing the number of daily cases handled.For example, a regular screening center could process two cases per hour (20 daily cases), whereasa drive-through center can process up to six cases per hour (60 daily screenings) [32]. Furthermore,the people being tested preferred the drive-through system because the waiting time for the test is farless and the queue time is spent in the comfort and safety of their own cars [48].

The most challenging task in controlling the spread of COVID-19 is making sure incoming internationaltravelers are not carriers of the virus. Thus, KCDC set up 16 walk-through outdoor screening booths (eightfor each of the two international terminals). All incoming passengers are tested as they walk through thestation at the rate of 5 min per person, screening more than 2000 passengers per day.

One of the most important aspects of suppressing the spread of the pandemic is the battle againsttime. Performing aggressive testing in a short period of time to identify and isolate confirmed patientsis the most critical operational strategy for flattening the curve of infection cases [49]. The screeningsystems discussed here represent innovations developed due to the desperate need to contain COVID-19at the most critical point of time, the beginning of the rapid spread stage [32].

3.2. Innovative Approaches to Addressing the Shortage of Healthcare Facilities

On 10 March 2020, the Korean government established residential treatment centers to treatconfirmed COVID-19 patients while maintaining their quarantine. In this residential system, each roomis occupied by one person as a rule, and all residents must conduct self-monitoring twice daily and areon constant monitoring and treatment by health professionals residing in these centers. Such centers’primary aim is to triage and categorize patients into four levels (mild, moderate, severe, critical),and the secondary aim is to manage patients with mild conditions. This system helps ensure thathospital beds are provided for COVID-19 patients needing critical inpatient care.

The resident treatment centers are managed independently by each local government. The primarygoal of these centers is to prevent the spread of the virus by treating, isolating, and medically monitoringinfected patients. While it is not necessary to send patients with mild symptoms to hospitals, it is stillnecessary to isolate them as they have the potential to widen the spread of the disease. Thus, these patients

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are the major targets of residential centers. To achieve their strategic objectives, these residential centersneed to make their operations flexible and dichotomous, encompassing both hospitals and centers.Hence, their provision requires accurate triage of confirmed patients, active participation by residents,and strict compliance with the care policies and regulations within the center. These residential treatmentcenters represent an innovative model of care that has helped prevent the spread of the infection to thecommunity while addressing the shortage of hospital beds.

3.3. Expansion of “Untact” (Non-Face-to-Face) Services

“Untact” means no human-to-human contact in service encounters [17]. During the COVID-19pandemic, Korea has been able to provide untact services to its population based on innovativeapplications of digital technologies. This operational strategy has contributed a great deal to suppressingthe spread of COVID-19 through an advanced healthcare system (e.g., drive-through screening centers).One of the best examples of such untact services is the self-diagnosis app and the self-quarantineprotection app [32].

On 10 February 2020, the Central Disaster Management Headquarters of Korea announced that itwas going to use a self-diagnosis app to monitor the virus infection status of all incoming travelersthrough a special entry procedure in order to strengthen infection management. This app monitorsthe symptoms once a day and provides a quick consultation by medical staff for everyone who entersthe country. After this app became mandatory, permission to enter Korea has been granted to onlythose (citizens and foreigners alike) who provided their personal information (e.g., name, passportinformation, nationality, and actual address) in the app. Anyone entering Korea must consent to usethe app and download it themselves as a special entry procedure. The results of the self-diagnosisfeature (i.e., fever, cough, and/or sore throat) are submitted to the corresponding public health centerand KCDC. Moreover, this app provides important information to the user about screening centers(i.e., the closest available area/location for inspection and contact information), the SNS channel ofKCDC, and 1339 consultation call centers.

Untact technology-based approaches are currently making a substantial contribution to addressthe challenges regarding patient management, shortage of healthcare staff, and lack of resources neededto provide a diagnosis. Additionally, aimed at healthcare providers, a dashboard was developed bythe Korea University Medical Center and Softnet to automatically send information about patients’(self-assessed) body temperature, symptoms recorded on the app, pulse and blood pressure (takenwith a Bluetooth blood pressure cuff) to healthcare providers [50]. The application of such innovativeapps involves a trade-off between the concern of staying safe from the virus and personal privacy [50].Nonetheless, these measures have proven to be essential for preventing the spread of the pandemicthrough prompt and convenient reporting of symptoms among all travelers to Korea.

3.4. Strategies for Pandemic Management

The crisis caused by a pandemic requires a robust response system to prevent global health,economic, and social disasters. The key lesson learned from the Korean experience in managing theCOVID-19 crisis is the importance of innovative response strategies at the onset of the pandemic.Based on the review of some of the experiences of sample hospitals and the practices that have beenproven effective, an innovative pandemic management system should include the following strategies.

3.4.1. Plans, Procedures, and Control

The pandemic response cannot be made by one independent organization. There should be acollaborative public-private partnership that can utilize the synergistic capabilities of governments, privateenterprises, healthcare institutions, university research centers, and volunteer organizations (e.g., Daegu’sCollaborative Network: Emergency Response Advisory Group + Daegu Medical Association + DaeguCenter for Infectious Disease Control and Prevention). Such a collaborative innovation partnership isimperative to generate creative strategies, operational plans, and detailed work procedures.

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3.4.2. Governance

When a collaborative system is established, especially with many volunteer entities, it is difficultto seamlessly execute strategies and actions in a timely fashion in the face of the rapidly spreadingpandemic. Thus, an explicitly designed governance system with clearly defined roles, responsibilities,and authorities is as important as the strategic plans.

3.4.3. Integration of Healthcare Delivery Systems

In the exponential increase stage of the pandemic infection, healthcare facilities in the ground zeroarea could be overwhelmed by severely ill patients, causing the collapse of the system. For effectiveresponse management, healthcare facilities in the affected area (cities and surrounding counties)should be integrated as an emergency response system. Then, the various healthcare facilities can bedichotomized based on their scale and core competencies so as to designate some as intensive carefacilities where severely ill patients are quickly assigned for treatment and others as safe facilitieswhere patients with non-virus related illnesses are treated [4].

3.4.4. An Effective Logistics System

Fighting a pandemic requires much more than simply testing and treating infected patients. It isessential to secure a sufficient quantity and quality of medical supplies, protection of frontline healthprofessionals, and secure supply chains. It is imperative to develop an effective logistics systemfor timely delivery of medical supplies (e.g., testing kits, medications, ventilators, additional ERfacilities, ambulances, helicopters, etc.). The healthcare delivery system is bound to collapse if frontlinehealthcare providers are infected because of insufficient or ineffective personal protective equipment(PPE) such as face shields, masks, and body covers (for head, hands, shoes, and body). In addition,stable and emergency supply chains are necessary to ensure timely supply of all medical and othersupplies in order to provide urgent care to the patients on an on-demand basis in the face of thepandemic crisis [8].

3.4.5. Devolution of Control and Execution

The spread of a pandemic is not even throughout a country or region. While a national pandemicmanagement center is necessary (e.g., KCDC) to develop nation-wide guidelines and strategies, each regionof the country has its own unique patterns of virus infection. Thus, each local area government or viruscontrol center should be allowed to establish its own strategies to control the spread of the pandemic. As thevirus spreads throughout the community at a rapid pace, the need for mature civic consciousness usuallygrows proportionately. The current physical distancing campaign is a good example. Many countriesincurred enormous damage due to citizens not abiding to recommended guidelines to prevent the spreadof the pandemic (e.g., social distancing, shelter-in-place, personal hygiene, etc.), awakening the need forsocial co-consciousness and citizen engagement [51]. Therefore, policymakers of the central governmentshould develop definite policies regarding the devolution of control and direction, which are required ofall citizens during the critical phase of a pandemic.

4. Lessons Learned from COVID-19

The COVID-19 pandemic has brought a total upheaval to the way people live, businesses operate,and governments function. The pandemic has infected more than 27 million people, brought profoundsadness to people who lost their loved ones (881,464 deaths as of 7 September 2020), and hundredsof millions lost their jobs around the world in a matter of several months. We must learn from ourexperience of failure, and some successes, so that we can be better prepared to prevent and managefuture pandemics. There are several lessons that have now been learned and identified as importantelements for managing a pandemic from the COVID-19 experience in Korea.

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4.1. Government’s Response Capacity

At the time of the MERS outbreak, the Ministry of Public Safety and Security of Korea sent out tipsto the entire population on how to prevent the virus via an emergency text message. However, this onlyoccurred during the early days of the outbreak, and the government’s crisis management system—whichshould have directed efforts to manage the epidemic—failed to function properly [10]. Consequently,despite having a response system for infectious diseases, the government failed to effectively executeearly responses and was criticized for aggravating the damage caused by MERS. This inefficacy ofearly responses resulted in human casualties, public anxiety, and substantial economic damage, all ofwhich revealed the weakness of the government’s infection crisis management system [52]. This failurenot only made the Korean government recognize the vulnerability of the national epidemic preventionsystem but also provided an opportunity to learn from the failure [31].

Leadership was recognized as a key contributor to the successful containment of the SARSoutbreak in Korea in 2003. Previous studies show that leadership has played a significant role in theeffective implementation of proactive measures and facilitation of inter-agency communication inthe face of an epidemic [53]. More specifically, during the current pandemic outbreak, the nationalcrisis management capacity which was strengthened due to the lessons learned from MERS helpedexecute necessary response steps at the critical early stage of the pandemic spread. An emergencyleadership team should be established with experts in the relevant fields to develop specific strategiesfor prevention, response measures, and medical treatment procedures to contain the pandemic.

The international media have been reporting Korean strategies and practices for controllingCOVID-19 as a model [44,54]. Most Korean provincial governments have been effectively containingthe spread of the pandemic without shutting down business operations such as restaurants, coffee shops,retail stores, and even golf courses [48,54]. Particularly, the international media praised Korea’s testingcapacity with its innovative drive-through and walk-through stations, rapid processing for results(less than 4 min), and the Korean government’s information management that did not require alockdown enforcement like Wuhan, China. The New York Times [55] reported that, if South Koreasucceeds in containing the infection as it has, it will set an example for the world to follow. Johnsonet al. [56] also noted that Korea’s advanced diagnostic capability was proven to be the enabler of itsmassive testing of more than 35,000 a day, while the U.S. was testing a mere 426 persons (reported on25 February 2020). Moreover, Health Korea News [57] reported that the mortality rate of COVID-19patients was only 0.7% among 10,000 infected patients during the early stage of COVID-19 spread. It isevident that the Korean government’s quick response capacity, information disclosure transparency,and implementation of innovative models to protect patients and healthcare providers were the keyfactors for early success in containing the pandemic.

Korea had a bitter experience with MERS which helped the government to learn from failures andthen establish a proven infrastructure to handle the spread of pandemics. A set of best practices, what isnow known as “the K-response model,” is based on standardized proven systems that can be appliedby all healthcare providers, including testing procedures, contact tracing, isolation by self-quarantine,hospitalization, treatment procedures of severely ill patients, and release after being cured. The controltower in central government and in each local government should proclaim a standardized preventivesystem (e.g., closing all large audience events such as sports, theaters, shopping centers or educationalinstitutions; limiting the number of people in any group gathering to 10 or less, with social distancingof 6 feet or more; the stay-at-home policy; closing all business operations for 2–4 weeks, includingall personal services such as hair salons, massage parlors, physical therapy centers, dental offices,etc.) [32]. The operating systems and strategies that the Korean government implemented to containCOVID-19 have proven to be effective.

4.2. Information Sharing and Utilization of Digital Devices

The Ebola outbreak in West Africa in 2014 caused more than 10,000 deaths with a 40% mortalityrate. The affected governments’ approaches to combatting the virus failed to foster trust among

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the citizens, causing fear, and inaccurate information led to a considerable amount of time spent ontracing the actual movements of those infected [58]. A previous study analyzed the outbreak of novelinfectious diseases since 1990, focusing on global pandemic management systems [11]. This studystressed the importance of transnational monitoring and information sharing about the spread ofdiseases (e.g., disease symptoms and infected areas). Another study investigated the outbreak of SARSand pinpointed the Chinese government’s failure to provide effective early response to the pandemic,either concealing or underreporting, as the reason for the global spread of the disease [59].

The Korean government, in response to the current COVID-19 pandemic, has been reporting thenumber of confirmed cases, the number of deaths, and the actual movements of confirmed patientsin real-time. Such government efforts for transparency and urgency regarding the pandemic havegained the public’s attention regarding the risk involved. Such government efforts also gained thetrust of citizens and helped people comply with issued guidelines. The government also announceddisinfection measures and schedules for locations where confirmed patients made contact with otherson a daily basis. This information indirectly advised the general public not to visit those hot spots. Inaddition, local governments sent out text messages to all citizens upon confirmation of a new infectioncase in their region and other helpful safety tips about the virus.

Such real-time information sharing about the pandemic has been possible because of the advancedmobile technology infrastructure and the public’s high mobile device usage in Korea. As COVID-19began to spread throughout the country in February 2020, various apps were developed rapidly byyoung entrepreneurs (e.g., apps showing confirmed patients’ locations, the closest place where masksand gloves can be purchased, assistance tips for self-quarantine, etc.). Currently, several Europeancountries (e.g., UK and Italy) are also attempting to utilize a GPS tracking system to locate confirmedpatients and to inform disinfection and prevention activity areas using smartphone apps. A team ofmedical researchers at Oxford University in England published a report suggesting that communicablediseases can be controlled effectively if many utilize digital contact tracing [60].

4.3. Community and Civic Consciousness

Based on the current COVID-19 situation in Korea, while the government’s response capacity iscrucial to prevent the disease from spreading, mature civic consciousness is essential to ensure socialcompliance with the imposed measures. In Korea, people did not engage in panic buying during theearly days of the pandemic outbreak. For example, when there was a shortage of masks, instead ofthe profiteering behavior of some hoarders, many people began to donate some of their daily allottedmasks to the community for those in need. Mass media also encouraged beneficence through publicemotions showing a strong spirit of community and unity. People recorded their daily lives in SNS,including health status and places visited, to help prevent the infection from spreading to others aroundthem. Some people even traveled only on foot to prevent spreading the disease in the community.Furthermore, people complied with the five-day rotating purchase system for masks, which wasinstituted by the government to ensure a fair distribution to everyone in the face of mask shortages.

The global media has praised Koreans for their voluntary civic engagement and compliance withgovernment guidelines to contain COVID-19. The Washington Post [61] reported that Korean citizenscanceled major events and most religious services were held online at the outset of the pandemicbreakout. Daegu, the epicenter of a massive spread of the virus, was able to manage the situationwithout a lockdown, as people in other parts of the country voluntarily refrained from visitingthe city. Moreover, the BBC News [62] stated that South Korea was able to manage the spread ofCOVID-19 without implementing a complete lockdown or strict measures against people’s movement.Koreans voluntarily wore masks everywhere outside of their homes and were tested for COVID-19,demonstrating mature community and civic consciousness. Responding together and responsibly tothe threat of COVID-19 have now become a battle cry for Koreans [63].

Contrastingly, there were cases where civic duty was not practiced. There were incidents wherepeople lied about their addresses, pretending to be from an area of mass infection, to receive priority

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care. There were also cases where people under the required self-quarantine violated the isolationguidelines and roamed around the community restaurants and coffee shops, thus spreading theinfection [32]. There was a major relapse of the virus infection after two weeks of almost no dailyinfection had been reported in Korea. During 24 April–6 May 2020, over 5500 young party goes visitedseveral night clubs in Seoul during the social distancing enforcement period. These clubs are knownfor their loud music, dancing, and drinking in a rather confined space. These clubs often restrict entryonly to young people, enforced by a reverse carding system (usually only under 40 years of age).Among those who visited the clubs, more than 270 infected people were identified by June 1. However,there was a social stigma issue (regarding the sexual orientation of many regular customers of theclubs) involved which made contact tracing difficult for those who visited the clubs. It was reportedthat many club goers falsified their names or addresses (e.g., cell phone numbers).

To suppress the spread of a dangerous pandemic, a spirit of unity and shared purpose is required.Korean people realized the potentially devastating chain of infection that could sweep through theircommunities and the country as a result of the misguided actions of a single person. In addition to thegovernment’s control measures, the public’s strict adherence to government guidelines and voluntaryparticipation in implementing certain rules (e.g., mask rationing) based on a sense of community haveplayed a major role in suppressing the spread of COVID-19 [32,62–64].

4.4. Innovative Application of Technologies

In response to the COVID-19 pandemic, physical distancing has been encouraged based onthe recommendation of the WHO [2,32,64]. As people refrain from engaging in outside activities,many businesses (e.g., restaurants) start to experience financial difficulties. The drive-throughCOVID-19 screening model has been applied to other businesses, and a new drive-through shoppingmodel emerged. For example, South Korea’s large seafood markets are utilizing their parking lotsto provide drive-through services, where customers can order sushi meals from their cars as theyapproach the market and vendors fulfill the order immediately. Department stores are deliveringpre-ordered products to customers at the valet parking service lot. In addition, services such asdrive-through book-lending and agricultural product sales have flourished [65].

Most of package and food delivery services have transitioned from personal service to the“untact” method that minimizes direct human-to-human contacts. Classes and lectures in elementary,middle, and high schools and colleges have transitioned to online platforms. Video conferencesand home-offices have also become the common method of running operations. Automobile repairservices now provide a “special pick-up and delivery” option to ensure that their services are untact,helping those customers who have hesitated to visit a service center due to COVID-19.

Diebner et al. [66] pp. 3–4 stated that digital delivery has become a necessity for “most customerswho are confined at home” and “that app downloads and new sign-ups have grown between 80–250%”during the COVID-19 pandemic. As COVID-19 has been reported to infect people via contact withinfected people’s droplets [32,60], untact services utilizing innovative technology applications haveflourished and are expected to expand continuously.

5. Conclusions

When a pandemic outbreak occurs, identifying the source of infection and suppressing its spreadare the most important steps. Amidst the COVID-19 crisis, healthcare institutions are like battlefieldmilitary units that are fighting an enemy with necessary weapons, albeit in the form of much-neededmedical supplies. In response to the pandemic emergency, many organizations have shifted toremote-working to ensure operational continuity and employee safety. However, many business firmsthat cannot operate remotely (e.g., manufacturing plants, construction sites, sports events, etc.) had tocompletely shut down business. Enterprises are scrambling to make fast adjustments to their disruptedsupply chains [8]. Educational institutions were ordered to shift the teaching mode from the classroomto the online educational environment. These are “new normal” in the COVID-19 crisis [2].

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This study reviewed the cases of innovative responses, as well as failures, to the explosive spreadof COVID-19 in Korea since the first confirmed case on 18 February 2020. Based on the review of thesecases, we summarized the lessons learned from Korea’s COVID-19 experiences. The knowledge gainedfrom the struggle against the virus provides new insights about required strategies for managing thepandemic. Our study suggests that the healthcare policy makers and related organizations must betransparent in demonstrating to the citizens that emergency healthcare services are being provided onan equitable basis throughout the country. Based on these experiences, policy makers should developstrategies that include the government’s response capacity, information sharing, mature sense of unityand community, and application of advanced technologies in the time of urgency.

5.1. Implications of the Study Results

The results of this study provide several theoretical and practical implications. First, the COVID-19outbreak taught the world that massive and rapid testing is essential to identify infected patientsand infection clusters to prevent the pandemic from spreading. The identified patients can be eithertreated promptly (severely ill cases) or quarantined. Second, we showed that the spread of an epidemiccan be effectively suppressed only through well prepared public health infrastructure; coordinatedand exhaustive efforts of the central/local governments, disinfection and prevention authorities andhealthcare providers; and the spirit of unity and community of citizens (e.g., adhering to the governmentguidelines regarding social distancing, stay-at-home, avoiding large gatherings of people, etc.). Third,innovative operational strategies should be established based on past experiences (e.g., the MERSfailures) in order to ensure success in managing the pandemic. In Korea, the primary cause of the earlyspread of COVID-19 was related to a mass gathering within a confined indoor space (e.g., worshipservices of religious organizations). The Koreans learned quickly about the perils of such undisciplinedactivities and their consequences in terms of the uncontrollable spread of the pandemic [32].

Moreover, the Korean government enforced an aggressive COVID-19 screening program topromptly identify and trace contacts made by infected people and treat seriously ill patients whilestrictly isolating them from the general population. Furthermore, these measures cannot be implementedsuccessfully without active cooperation of the citizens. From the outset, the government asked all citizensto refrain from participating in group gatherings or events, both indoors and outdoors, that could pose athreat to others, and strongly encouraged the practice of physical distancing. Moreover, the governmentalso placed a legal liability on agents who proceeded with non-recommended events. A mature civicconsciousness is needed to voluntarily comply with government guidelines.

A crisis is said to be a combination of danger and opportunity. President John F. Kennedy analyzedthe word “crisis” in Chinese and pointed out that the word consists of two characters, one representingdanger and the other representing opportunity [67]. Winston Churchill’s famous quote was also in thesame vein, “A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity inevery difficulty” [68]. These quotes serve as reminders that every crisis encompasses opportunities forcreating a better future. The Koreans have learned this lesson from their experience with the COVID-19pandemic. Therefore, we might view the crisis from the perspective of “crisis = danger + opportunity”based on response efforts.

The COVID-19 crisis shows how each country organizes the delicate balance between achievingefficient results (avoiding high rate of mortality) and intrusion on personal privacy and economicsecurity. This means that there is a trade-off relationship between two important factors in life: healthand economy. For example, much of the offline education system will most likely transition to theonline environment, causing a trade-off relationship between students’ face-to-face education needsand a safer/cheaper mode of delivery.

The measures undertaken by the Korean government to avoid repeating the same mistakesincurred during the MERS outbreak (i.e., re-organization of the KCDC, the healthcare delivery system,and disinfection and prevention systems, as well as the expansion of healthcare facilities) were shownto have a significant impact on the effectiveness of the implemented response strategies in the face of

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the COVID-19 pandemic. Therefore, developing an effective public healthcare infrastructure and newoperational strategies based on past experiences could turn a crisis into an opportunity for preventingsuch virus infections [5]. We are confident that the fear of COVID-19 that is currently sweeping theglobe will soon be overcome and hope that this costly experience will serve the world well in preparingfor the next pandemic.

5.2. Limitations and Future Research Needs

This study has reviewed the response strategies of Korea in dealing with the COVID-19 pandemicoutbreak. Korea’s pandemic management approach, known as the K-response strategy, has beeneffective in containing COVID-19 as the country learned a bitter lesson from the pains of MERS andreinvented its public health infrastructure as a preparation for the next pandemic. We do hope that theoperational strategies of Korea discussed in this study would help prepare effective crisis managementsystems in other nations. This study, however, has some limitations. First, the scope and experienceof the COVID-19 cases discussed in this study are specific to Korea. Thus, the results of the studyhave limited generalizability to other situations or countries with different cultures and social systems.Future research that includes various cases from around the world would further reinforce the findingsof our study. Second, the COVID-19 pandemic is still causing havoc around the world and its end isdifficult to predict. Furthermore, the world will surely encounter new coronavirus pandemics in thefuture. The results of our study are limited to the discussion of COVID-19 that we are battling today.Thus, new pandemics will require different research approaches, although the lessons learned from thecurrent pandemic will certainly be of much value.

Author Contributions: All authors have conceptualization, writing, and read of the manuscript. All authors haveread and agreed to the published version of the manuscript.

Funding: This research received no external funding.

Conflicts of Interest: The authors declare no conflict of interest.

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